BME Summer Immersion 2021

Hi, everyone! My name is Samantha Bratcher. My clinical immersion is with Dr. Adam Talenfeld and Dr. Kyungmouk Steve Lee in the Interventional Radiology (IR) department. Although it's not very related to my field at the university (biomechanics/mechanobiology), the clinical experience has still been very interesting. The IR department is super friendly and all the clinicians have been very available to letting me shadow them. It's only been one week, but I've already learned a lot! Every day has been watching something new, from angioplasty to biopsy to embolization. I find it so crazy that they're able to thread a wire through someone's veins to practically any area of the body. It's always a bit crazy to watch. I got a video of a balloon angioplasty using this method. The balloon is inflated inside a person's veins to expand them and increase blood flow. The second video shows the veins and their quality. The rate at which the contrast dye flows through is...

A slow week this week. I was a bit unlucky and had to present my research project today instead of next week. The research isn't difficult, but it is a bit hard to interpret. I've been using the Manufacturer and User Facility Device Experience (MAUDE) database to view reported complications with vascular closure devices (VCDs). However, reports are very subjective. It's up to the reporter to decide what the device and patient problem is. I'm attempting to simplify some of it, but it takes a lot of manual assessment. Dr. Talenfeld gave me an interesting compliment, though. "That was delicious lemonade made from reasonably delicious lemons." I kinda like it. I think I might start using it. I've gotten used to seeing many of the standard procedures done in IR, like biopsies and catheter placements. I did get to see a uterine fibroid embolization this week, though. Conceptually, this is very similar to the Y90 treatment I mentioned in my Week 1 post. Uterine f...

One thing I really like about the IR department is that there are always procedures to see. Many of the patients that need to be seen are referred to the department; so, time in the clinic seeing patients isn't very common. Although there are many commonly performed procedures, I've still managed to see a new one just about every day I've gone. This week was a bit slower, being a 4 day work week. I got to sit in consults with Dr. Malhotra. In consults, the clinicians take turns spending the day with a team of people looking at cases (new and old) and judging what should be done. Dr. Malhotra goes very quickly, but I learned a lot of new medical terms and markers. I also spent one day shadowing Dr. Jason Spector in plastic surgery. I saw a fat graft, breast reduction, and nasal reconstruction. In the fat graft, fat was removed from a woman's abdomen and thighs and placed in her jaw. What I found interesting was how they isolated the fat. When first removed, the fat is ve...

This week I got to join Dr. Talenfeld in the clinic. Since most patients are referred to the IR department, clinic visits usually consist of explaining the procedure that will be done, answering questions/concerns, or discussing how the patient is following the last procedure/next steps. Many of the patients who come to the IR department have cancer. Dr. Talenfeld was familiar and had a relationship with his patients, which I liked to see. He cared about what his patients had to say and explained things as many times as needed. In a time where it feels like general society is caring less about science, forming trusting relationships with patients is important and beneficial. I also spent a day shadowing Dr. Schwartz in nuerosurgery. It was pretty intense to watch. I saw two parts of a brain resection to treat epilepsy. In the first, they placed electrodes into a girl's brain. They had a robot which could show the surgeons where to enter and the entry angle to correctly place the le...

The final week! This week I watched a kidney biopsy and ablation and a bone biopsy. Biopsy involves getting small cores of tissues from a tumor or mass. Ablation is a technique used to destroy tumors. This can be done with heat or cold. Thermal ablation can further be accomplished using radio frequency or microwaves. However, when heat is used, the doctor must also account for "burn back." Heat is difficult to control precisely and will diffuse to surrounding healthy tissues/organs back along the probe. Hydrodissection injects saline to push organs away from the burn area, protecting them. The craziest part, though, is that they do this with the patient awake (but sedated) and insert a long needle through the torso. The bone biopsy was similar, but a drill had to be used to go through the bone and cut a small cylinder out of the suspicious area. For my last weekend in NYC, I went to Luna Park and the Coney Island beach. Personally, the ticket price for Luna Park wasn't wo...

Another week gone by. I've continued to enjoy shadowing the IR department. I think the best description is interesting but not exciting. That isn't to say I don't like it. I think the techniques and devices they use are impressive from an engineering and medical standpoint, but a good chunk of time is always spent to check and double-check the doctor is in the right location. The actual doing is usually fairly quick. It's very different compared to something like plastic surgery, in which there's more cutting and suturing involved. Some procedures are very common in the IR department, like biopsies, venograms, and drain placements. One of the more interesting ones I saw this week involved the placement of a fistula plug. It's a small device made of collagen shaped almost like a nail. After placing it into a fistula (an opening from outside the body into an organ), the body will naturally degrade the material and replace it with healthy tissue. After 4-6 weeks of...